Abilify, Not I : Adventures in Antipsychotics

Lately, I have written a series of posts over the last two months describing certain troublesome symptoms I associated with the worsening of Bipolar Disorder, or the potential for comorbid disorders.

In my last post, When Medications Go Wrong, I briefly wrote about my recent discontiuation of the pharmocological treatment using Abilify as part of my medication regimen:

Recently, I stopped my Abilify.  Admittedly, it was because I noticed an interaction between the Abilify and my weekend consumption of alcohol.  I started to find that I would fall asleep soon after taking it on Friday’s while we drank.  I decided that I would just stop over the weekend, and continue during the weekdays as normal.  But, eventually, I just forgot to take it at all.  And soon, I started to notice an improvement in my worsening condition.

I went on to describe some of the awful side effects I was experiencing as a result.  However, the list was truncated for the sake of keeping word count down.  The description is rather limited in terms of accurately depicting exactly what I was subject to.

  • Cognition Disturbances and Memory Fragmenting.  Originally, I wrongfully blamed Lamictal in Vitamin L : Medication Adventures for my aphasia-like symptoms.  The disturbances felt like aphasia.  At first, it was almost indescernable.  I started word dropping again, meaning I would be reaching for a word, but was unable to grasp it.  Instead, I would be able to get to every synonym around it, however, those words did not fit the exact context.  Eventually, it became a more severe form of word dropping, and I found myself dropping sentences entirely at the loss of any word or synonyms around it.  It progressed into entirely dropping conversations at the loss of a sentence.  Then, I found myself

    I started forgetting things again.  These were simple things, like losing my purse or shoes in the house.  It seemed like just a simple case of forgetfulness, maybe stress related.

  • Emotional Blunting and Partial Flattening.  I had never had too much trouble with emotional blunting in the past.  While I’ve found myself in times where it was difficult to express my emotions, this didn’t indicate a lack of emotional response.  I describe it as a partial emotional flattening, because it wasn’t an entire lack of reactivity.  It felt like my spectrum of emotions had been significantly reduced, although not completely removed.  There was a certain inaccessibility to certain strong emotions.  Rather than completely removing extreme emotions, it threw a wet blanket on top of them, leaving them to bubble under the surface.  So, the emotions still existed, but were muted and unable to be adequately expressed.

    At it’s worst, I began to lose most feeling entirely, with the exception of irritation and the sensation of boredom and fatigue.  I began to lose love and my attachments to meaningful people and my relationships with them.

  • Dissociation I touched on a summary of the dissociative symptoms that Abilify had brought on.  I have been writing articles on the experience throughout the last few months on the subject, describing the feeling in great detail, but remained unable to exactly identify is appropriately.  The dissociation probably occurred as a response to the prior bullet points.

    The dissociation cited was experienced as a removal of self and removal from my own life.  I had felt as if I had been separated from myself and my world.  It was a feeling of something being stolen from me, or something fundamentally inaccessible.  Like, I was being locked out of my own life, or becoming transparent and just fading away.

  • Worsening of Depressive States.   This is probably a direct result of the first three bullet points.  I started to disengage from my life.  I lost interest in just about everything.  Most things were considered to be either boring or tedious.  Important things started to lose meaning.  This was experienced as a part of the emotional flattening, but it caused a concerning and distressful reaction.
  • Exacerbation of Social Anxiety Since I had lost the ability to carry on a conversation and found myself completely disinterested in socialization, my social anxiety went through the roof.  I simply didn’t care about anything anymore, especially trivial things I used to find interest in.  Therefore, I found it difficult to carry on a conversation.  This caused extreme distress in social situations, and encouraged further isolation.
  • Disturbed Sugar Levels.  While I have no concrete proof in terms of tests, certain symptoms have come to my attention.  They are notated below in the next two bullet points as thirst and weight gain.
  • Loss of Sensation of Bodily Hunger, Thirst, and Fullness.  Within the last few years, I started to become more in tune with my body.  I was able to feel the sensations of hunger through my sugar level, which probably caused the loss of bodily hunger.  The disturbed sugar levels probably also caused an extreme thirst that could not be quenched.  At first, I craved water.  Eventually, I started to put the soda back down, which probably caused part of the weight gain mentioned below.  And I felt an extreme pressure in my stomach, which was also exacerbated by the influx of so much fluid.
  • Extreme Weight GainTruthfully, I don’t dare get on a scale at the moment, so I am unable to notate at this time exactly how much weight I’ve gained.  By the fit of my clothing, I will estimate that I have gained somewhere between ten and fifteen pounds in the last three months.  That is a substantial gain for me, especially since I was losing weight prior to the start of this medication.
  • Exacerbation of Eating Related Problems.  By all definitions, it’s completely possible that I am living with an undiagnosed eating disorder.  However, I am not entirely convinced, since it isn’t an ongoing and prevalent problem.  Therefore, I define it as eating related problems and difficulties.

    The concern for weight gain and the sensation of fullness caused a very terrible reaction of binging and purging.  I was unable to control my eating, as notated above, therefore the sensation of extreme fullness would cause me to perceive the overeating as worse than it actually was.  Unfortunately, this led to a very vicious cycle and encouraged further weight gain.

  • Disturbed REM Sleep.  I was waking up tired, and noticed that it felt like I had stopped dreaming.  This caused my mental state to take a considerable dive.  It caused extreme fatigue and excessive, unproductive sleeping.

While I am cleared of most dissociative symptoms, emotional flattening, and my depressive state is lifting a little, some side effects have remained.

  • Cognitive Disturbances.   The aphasia-like symptoms remain, but to a lesser degree.  I am back to just being a little forgetful, and have some minor word dropping.
  • Memory Fragmenting.   Some of my memories remain dull, but seem to be returning.  However, most of the last three months remains inaccessible.  It may never become accessible, due to the disruption in the formation of short-term memory.
  • Disturbed Sugar Levels.   I am still thirsty, but I am no longer engaging in carbohydrate seeking consumption behavior.  I figure it will take awhile before my sugar is regulated properly again.
  • Weight.   Thankfully, my weight does seem to be coming down.  I have only been completely off of the medication for less than a week, and my clothes are already fitting better.  I’m going to assume that in addition to the weight gain, I was retaining water and constipation.  My regularity has come back, and I don’t feel as puffy as I did

Unfortunately, I am experiencing a return of some of my milder psychotic symptoms.  In Imaginary Enemies, I described a cognitive disturbance I described as “The Voice”“The Voice” can be characterized as a singular persona, as I wrote about in Conscious, Subconscious, and Extraconscious, where I described a theory of a third consciousness that exists between the subconscious and the conscious mind.

The Extraconscious is postulated as where the persona(s) reside, laying in semi-dormant waiting, perfectly aware of the current reality that is being experienced.  “The Voice”, in more severe psychotic states, can be experienced as a separate entity entirely, detached from the consciousness.  That is the defining line between a cognitive distortion and an auditory hallucination, when a persona detaches itself from the extraconscious as an external sensation.

As an extraconscious persona, “The Voice” can best be defined as a quasipersona, lying somewhere between Dissociative Identity Disorder and psychosis.  It is experienced as a semi-active part of the conscious mind, as the dominant persona is well aware of it’s existence and there is a certain interaction that occurs between the dominant persona and “The Voice”.

That is the best theory I can offer as to the existence and function of the quasipersona, known to me as “The Voice”.

The mild auditory hallucinations and visual hallucinations have returned, probably defined better as a sensory disturbance, rather than a symptom of psychosis.  When experiencing a sensory disturbance, it’s not full on hallucinations as described in the definition of psychosis.  There are not entities separate from the body.  They are recognized as a disturbance in the current reality, distorting shapes, colors, and contrast in the vision.  In the hearing, it is experienced as a distortion in sound, causing sounds to be sharper, duller, muffled, or louder than they actually are.  It can only be sensed by a sudden shift in perception.

So, instead of hearing things at a normal sound level, the sound volume may increase to deafening levels or may become muted and difficult to discern from nonexistent static that occurs in the mind.  My visual disturbances may be perceived as viewing the world in high contrast, extremely bright colors, and / or extra high definition resolution.  Or, they may be seen as duller than usual, muting colors, distorting shapes, and / or clouding the vision with that appearance of a veil or foggy goggles.

Intrusive thoughts have returned, but not with the same extreme nature as experienced several months ago.  In truth, they were never completely removed by the Abilify, and at some points were made worse by the drug.  Instead of experiencing them as a truth in reality, I am now able to separate them using logic.  I can talk myself off of the ledge and separate them from the reality of a situation using DBT techniques of mindfulness and distress tolerance.  Prior to the cessation of Abilify, I was unable to utilize those techniques.

I don’t mean to put anybody off of treatment with psychiatric medications, but I felt this was important to document and have as a resource on the internet for anyone who is thinking about taking the drug.  Some of these side effects aren’t listed in the pamphlet, as they are probably isolated to a condition.  But, I feel they are still a distinct possibility for anyone who is being treated for similar conditions.  It is vital that this information be notated and readily available for medication education purposes.  This information probably should not be generalized to all psychiatric medications, especially in the class of antipsychotics.

 

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The Friday Confessional : Baby Weight


TRIGGER WARNING : This post contains material that may be a potential trigger for some.  It’s contents include talk of eating disorders and self-injury.  If you are sensitive to this material, please use your discretion before reading.

I am by no means a thin woman.  As a matter of fact, according to my BMI, I am actually slightly in the overweight range.  It’s not really unusual for a person who lives in the good ol’ US-of-A.  Obesity is considered an epidemic in this region of the world.

I have bad body image.  This started as a very young child when the other kids would pick on me for being overweight.  At that point, it wasn’t my fault.  I wasn’t responsible for my diet, and my family had terrible eating habits.  In fact, as I started to notice while my parents were watching my child, they encouraged recreational eating for lack of other engaging activities.  As a result, I ended up a fat, miserable kid.

I remember I stopped eating my lunch at one point.  A lunch aid came over and asked what was wrong.  I recall telling her, “I’m on a diet.”  She looked shocked and appalled.  Now that I’m an adult, it’s completely understandable.  I was eight, and I was confessing that I was unhappy because of my weight.  To her credit, she attempted to explain to me that I had a lot of years to grow into the weight, and it was unhealthy to deprive myself of food.

Essentially, she was trying to talk me out of developing an eating disorder.  Unfortunately, talk is too cheap when you’re eight.

Eventually, people close to me stopped mentioning my weight.  And I continued to grow.  By the time I was in the fifth grade, I was obese.  I was eleven, 4’8”, and weighed approximately what a fourteen year-old 5’1” teenager should have weight in a healthy weight range.  My clothes continued to shrink rapidly, and the only excuse my mother could come up with was that I was just “having a growth spurt”.

It wasn’t lost on my peers or teachers, though.  While I had the brains, I didn’t have the body.  And the outside was all that mattered.  Summer break came, and I was about to enter middle school.  It was at that time that I decided that I would shed my “baby weight”, as people were so eager to call it, and become a slender woman.

That was the summer where it all began.

The real secret is something I’ve hinted at throughout the last year, but could never bring myself to actually come out and say.  Even now, I find myself typing and retyping the sentence that will start to change everything.  It will change how people think of me, and how people treat me.  It will have people worry and watch me like a hawk.  And those are all things that I’ve tried to avoid over the years.

I have undiagnosed disordered eating.

As a child, it developed from recreational eating into comfort eating.  I would gorge myself far beyond bursting, to the point of where it felt like the contents of my stomach were backing up into my throat.  The act of eating was comforting and satisfying.  The sensation of fullness seemed to fill this hole inside of me.  It took away the emptiness that I had tried so hard to fill with accomplishment.  Even for a moment, I was full.  I was whole.

That led to another problem.  Childhood obesity.  And the lack of friends I had resulting from my obesity and the intimidation of my perfectionism and accomplishment created an even bigger hole.  What started out as a small snag in the woven fabric of my life started to unravel into a gaping hole, threatening to tear seam to seam.  Comfort eating turned into binge eating and created a cycle that continually fed into itself.

The summer before middle school, I decided to start dieting.  How absurd – an eleven year old on a diet.  I restricted my food intake to half of what I was eating.  I refused to eat between meals.  I started both biking and running once a day for at least an hour.  When my clothes started to become loose, it only served to encourage all of these behaviors.

I was a child on a mission.  I started only eating half of what I was eating, leaving me eating meals off of saucers.  I added running stairs onto my exercise regimen.  I would spend a half an hour each day running the basement stairs, as to not bother my parents.  My clothes became so loose that I became reduced to wearing my 90lb mother’s clothes.

I had done it.  In fact, I had done so well that most of my peers didn’t recognize me anymore.  Many people started referring to me as “the new girl”, as I didn’t have any friends to correct them.  And much to my surprise, those shallow little girls I had come to despise welcomed me to their clicks with open arms.  I was no longer intimidating or disgusting.

Throughout the years, my weight bounced up and down.  I would binge and then go on an exercise craze.  In my mid-teens, I discovered those ephedra pills that could be found at any gas station.  Friends and I would take handfuls of them and stay up, bouncing off of the walls, for 72 hours at a time.  I remember lying in bed just vibrating, desperately mentally exhausted, but completely wired.

My relationship with my first love, my high school sweetheart, started going south around the time that I was seventeen.  And the binging started once again.  I hated myself for it, and I watched myself grow out of my clothes once again.  I knew he had to have found me repulsive, and I knew he was eyeing other women.  But, it only served to make it worse.

I will never forget this.  I had my eighteenth birthday at my boyfriend’s place.  I was surrounded by many of my friends, and we ordered several pizzas that I paid for.  I watched all of the girls daintily eat one or two slices of pizza, when I realized that I had gorged myself on four.  I looked at their slender bodies with envy.  What a disgusting pig I am!  I thought.  No wonder I’m so fat!

I went to the bathroom and locked the door.  I leaned over and stared into the bowl.  I was about to do something that we all had accused and ridiculed thin cheerleaders for.  It was this, or being doomed to a life of obesity and loneliness.  I extended my index finger and pressed down on the back of my tongue.

The vomit came pouring out like a fountain into the bowl.  The taste was awful, like orange juice mixed with something foul.  But, the sensation was incredible.  I could feel the load lightening, and my stomach shrinking.  I did it again, this time making myself gag harder, almost to the point where I made an audible noise.  It felt like all of the awful feelings were just pouring out from inside of me.  It was almost like cutting, but without any noticeable tell-tale scars.

I purged until there was nothing left but stomach acid.  I sat against the door, breathing heavily and relishing in the hollow feeling in my belly.  There was something so beautiful about feeling that emptiness.  It ached, along with my raw throat, and the bitter aftertaste of vomit in my mouth.

This doesn’t happen regularly.  It only happens when I have a severely awful body image.  My clothes start to get tight, and automatically, my stomach starts to churn, as if it knows what’s about to come.  If I’ve eaten just before a fight with someone, I find myself getting queasy and running for a bathroom.  If I am rejected, I automatically assume it’s because I’m not attractive.  I find myself hell bent on getting back a body I once had.

But even worse is when I do it as a form of self-injury and control.  I binge, feeling the sensation of my belly swelling with all of the emotion I can’t experience.  The contents rise into my throat, without a place left to go.  I excuse myself and wrap myself in an awful embrace with that cold, unforgiving porcelain.  For a moment, just a brief shining moment, I stare into the bowl, trying to talk myself out of it.  There’s no other way.  I lean in, and the deed is done.

And each time, the whooshing of the flush brings shame to my already teary eyes.  I stare at the bloodshot eyes, ringed with raccoon eyes.  My face is red and looks exhausted.  All I can do is take to cleaning up the mess I created.